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Introduction Venous sinus stenting (VSS) has emerged as a promising minimally invasive treatment for idiopathic intracranial hypertension and pulsatile tinnitus with associated venous sinus stenosis. However, severe stenosis can be difficult to cross with stent delivery systems. Balloon pre-dilatation is sometimes required, which carries its own risks. We evaluated if crossing stenosis with the Carrier (Balt, Irvine, CA), a tapered hydrophilic delivery catheter, decreases the need for balloon use and compared the safety, feasibility, and clinical outcomes to a pre-Carrier cohort.Methods A retrospective chart review was performed at a single center for all patients undergoing VSS over a six-year period. Demographic data, comorbidities, and procedural details including pre- and post-stent venous pressures, trans-stenotic gradients (TSG), and adjunctive balloon use were recorded. Chi-square, Fisher’s Exact, and independent t-tests were performed for comparisons.Results A total of 405 patients were included, with 327 in the pre-Carrier cohort and 78 in the Carrier cohort beginning in April 2024. Both cohorts achieved equivalent and near-complete TSG elimination following stenting ( p<0.001 for both), confirming comparable procedural efficacy. Notably, the Carrier cohort demonstrated a nearly three-fold reduction in the need for balloon-assisted stenting compared to the pre-Carrier cohort (6.4% vs 17.4%, p=0.014).Conclusion Adoption of the Carrier delivery catheter for VSS procedures was associated with a significant reduction in the need for balloon assistance, suggesting improved navigability and technical feasibility across challenging venous anatomy compared to previous microcatheters. These findings support the Carrier as a preferred microcatheter platform for simplifying VSS procedures and reducing risks associated with balloon usage.Disclosures A. Karkare: None. V. Sridhar: None. C. Werner: None. S. Mehta: None. J. Bassett: None. T. White: None. A. Patsalides: None.